Does it have to be one or the other… What if there is a ‘third way?’
Patient-centered care has pervaded a great deal of discussion amongst allied health circles recently. A drive towards greater patient involvement in the decision-making process has [rightly so] become a priority for many health professionals. Our goal is to empower patients to become active participants in their care.
In conjunction with this, there has been harsh criticism around the use of manual therapy, dependency for routine care, and ongoing patient management.
Regardless of the outcome, patient-centered, and practitioner-directed care, both require health providers to offer good communication and build trust in an effort to address patient needs effectively.
Whichever side of the fence you sit, our guiding intention is to help people. Industry, academic training and philosophy aside, practitioners draw on their expertise, tools and credibility to educate patients towards an improved quality of life. If we remove our misconceptions, bias and assumptions, allied health professionals are all on the same team, watching from the same side-line, playing the same game. The winners being the patient/client [person].
Patient-centered Vs Practitioner-directed care… Why does it have to be one or the other?!
There is a third way, and one that [I believe] many of us do already — that is, leading with libertarian paternalism.
Is it not possible and legitimate for a practitioner “to affect a behaviour while also respecting freedom of choice, as well as the implementation of that idea?”
The term libertarian paternalism was coined by Thaler and Sunstien in 2003 and has been the focus of countless studies since, particularly within political and economic industries.
We too use paternalism in healthcare to influence patient choices in a way that will make ‘choosers’ better off, as judged by themselves.
No one argues that individual choices should be free of interference. There will always be unethical practitioners with false agendas, but most work on the conviction of ‘do no harm’. With that in mind, we should be able to offer our advice and then let the patient decide. In fact, that is what we are paid to do?!
There are many instances where, if given free choice without paternalistic direction, people do not make the best choices.
It is the same reason superannuation what introduced; without government directive it was proven that people did not sufficiently save for their future.
It is the same reason cafeterias position ‘junk food’ towards the back and remove it all together in some school canteens. Because when the ‘yummy stuff’ is placed in front, research tells us that people do not tend to choose the healthy options.
People crave direction from credible industry authorities to be able to make informed decisions.
Healthcare is no different.
“I advise you take a short break from running.”
“It’s my recommendation that you keep moving.”
“To prevent further damage you should consider non weight-bearing activity.”
As healthcare providers we have a responsibility to direct patient’s towards the best possible outcome, educate them, and allow them the freedom to choose.
If that is manual therapy, so be it.
If that is a strength and conditioning program, so be it.
We advise, they decide…
We collectively explore their goals, they choose…
We listen, they share…
We empathise, they thrive…
We recommend, they consider…
Practitioner-direction COUPLED with patient-centered care IS libertarian paternalism. The two are not oxymorons.
We facilitate AND we advise.
If we drive exclusively toward patient-centered care alone, my fear is that it carries a false assumption of two misconceptions…
1. The false assumption that people always (usually?) make choices that are in their best interests.
2. The second misconception is that anything outside patient-centered care involves bias and coercion.
Food for thought… literally…
In Growth & Gratitude,